Curious to see if it's just me.

I came across this summary on AHRQ's website (AHRQ is a U.S. government agency that, among other things, conducts and summarizes health care research).  I'm used to seeing generic references in the media to "diabetes" and being annoyed by it, but AHRQ is a reputable entity involved in health care research, so I found this disturbing.

The original study (by Jason M. Fletcher, PhD, and Michael R. Richards, M.D.) appeared in a recent Health Affairs journal.  In summary, they found that people with "diabetes" had lower lifetime wages and higher high-school dropout rates.  In the full article, the authors briefly mention that they didn't attempt to differentiate among the various forms of diabetes, and kind of acknowledge that there may be some variation depending on the form of the condition in terms of effect.  But they stop there (why, I don't know). 

What really bugs me is how AHRQ presents the information on their website.  They do the classic "diabetes is rising with obesity" schtick, as well as stating that prevention, especially for children, is important because of these negative effects of diabetes. Now, while I know the rates of type 2 diabetes are growing in the U.S., my understanding is that type 1 diabetes is still the more common form of the condition diagnosed in children.  And as far as we know, type 1 diabetes cannot be prevented. 

I am annoyed on so many levels by this piece on AHRQ's website. As a T1, I know that the driving factors that affected my education and career choices were largely due to my ability to get health insurance and enough money to buy insulin and the other stuff I need to stay alive.  This has HUGE implications in the health policy world, but it seems to be largely ignored when looking at "diabetes" in this generic way. 


Does anyone else get annoyed with studies like this?  I just find them so...irresponsible.  Is it wrong to think that physicians should realize that they are dealing with multiple conditions, all of which can have different methods of management and impacts? 

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It seems like the study is sociological in nature and doesn't look at "cause" as much as "effect." If they have data to substantiate their conclusions, they seem reasonable. It doesn't guarantee anything, but looks at societal trends.

Where do I file my claim for $160K? I agree the survey is really annoying but if the data substantiates the conclusions, perhaps other questions might be raised, like why is it hard, what barriers (# of test strips, medical incompetance, weak support from the medical industry, incompetant support from insurers) preclude PWD from competing equally and what can be done to help us, without raising taxes.

If I recall correctly, the study does go on to discuss causes of these differences. The authors briefly note that they were unable to differentiate between T1 and T2 diabetes, but don't really discuss that further in terms of how it could affect causal factors (such as, most obviously, age of onset and insulin dependence).

Even from a psycological point of view type 1 and type 2 diabetes are different and require different attitudes. Just to simplify, type 1 requires mainly counting, checking, beeing alerted and continuous thinking while type 2 requires diet discipline and change of life style.

I think it's impossible to change diabetes type 1 name, but we could ask to be mandatory to always pair the term "diabetes" with type 1 or type 2, setting the word "type 1 diabetes" and "type 2 diabetes" (and "LADA diabetes") as the only, indivisible "true" names and forbidding the term "diabetes" as misleading and false because it doesn't exist such a illness, there are more than one totally different.

I always try to call things out that refer to "diabetes" in a generic way. The causes are so different, as are, on the average, the modes of treatment and management. I know that some T2s take insulin, but I would guess that most (??) can use oral medications and diet/exercise as primary management tools. Also, the average age of onset would seem to make a HUGE difference in the factors that drive the findings of this study. T1 is diagnosed primarily in young adults under the age of 30, whereas T2 is still primarily diagnosed in adulthood. Because educational and career choices are largely made in young and early adulthood, it seems that this is something significant.

I did not see anything wrong with the study. In fact it's nice to see any .gov take some interest on our side.

The researchers note that...[prevention, especially for children, might take on a renewed urgency for parents and other stakeholders once they become aware of how soon the effects of diabetes emerge and how profound the impact is later in life. This study was supported by the Agency for Healthcare Research and Quality]  (HS17589).
In the past diabetics stayed hidden in the shadows, their family's did not share information good or bad. We did not expect the government to step in and help us but if there is to be some government assistance we will have to show main street that we are entitled to some help, it seems like in today's world there are groups that expect help or some type of entitlements because they are diffrent than main street....I'm not sure (Type1) scores high enough in public interest but if we where contagious like Polio there would  be a greater understanding of cause and effect maybe even a cure....;-)

I had a good job with a large public held manufacturing company, was a board member at 40+ years old when they found out I was insulin dependent  they trashed my job and my dreams...the worst impact diabetes has had on me has been when I have let others (main street ) see inside my world and they see insulin dependance as a weakness.

Like AR said, where do I file my claim, if the government is suppose to protect me from injustice I have a long list , where is my check...:-)

The study goes on to discuss causal factors for why "diabetics" have lower wages and education. Do you think that these causal factors are the same for both T1s or T2s? Or would you agree that because of differences in treatment (T1s are almost always insulin dependent) and age of onset (T1s are still primarily diagnosed in childhood or young adulthood, when decisions about education and career are being made), there could be difference reasons driving these differences for each group? 

Just curious but how did the company you worked for damage your career upon finding out you had T1 diabetes?  I am not doubting at all that these things happen, but have been fortunate enough to never experience direct and blatant discrimination.  Did you sue?  If this is not something you want to share, I understand, but I am always curious to hear about situations like you describe.  Honestly, there have been occasions where I have not discussed being a T1 diabetic for fear that it would hurt my career in some way, but they have thankfully been few and  far between.

Yes, but CDC collects loads of data and still does a lot of reporting about "diabetes" in the aggregate. This bugs me because CDC has the resources and abilities to differentiate. They just don't. They lump all diabetics into one category, and I think it does every with some form of diabetes a disservice.

I would disagree with categorizing people as "controlled" vs. "uncontrolled" based on A1C. I can have a decent A1C, but have BGs swinging wildly from one extreme to another. Also, just because a T1 has an A1C that is "good," it does not mean that he/she won't develop complications. T1 is more complicated than just A1C when it comes to complications. Studies are just beginning to show that, for T1s, the inability to produce other hormones via the beta cells (c-peptide, amylin, etc) may very well affect the development of complications inasmuch as A1C.

In the case of this study, which attempts to surmise what factors would lead to these education and career outcomes, I really do think that the type of diabetes does play a role, and combining them is glossing over some significant issues.

For example, the average age of onset for T1 diabetes is still significantly younger than the average age of onset for T2 (trying to find stats on that - if anyone has them, please let me know). When you're diagnosed with T1 as a child and need insulin to survive, this can have HUGE impacts on whether you are able to go to college, what kind of career you choose, etc.

In addition, pretty much all T1s are insulin dependent. T2s vary in this regard. I know that the need for health insurance has had a huge impact on my career and educational choices.

The issue is that this study was done in effort to draw conclusions about why these outcomes exist for diabetics (lower income, less education). Because the two conditions are so different (average age of diagnosis, medical needs, etc), the driving factors affecting these two things is likely to be different as well. It just seems very irresponsible (to me) to post such a major finding and lump all diabetics together.

Just seems like bad science to me. It also bugs me that the CDC continues to lump all "diabetes" into one category.

I really get annoyed just because of some of my past experiences. Trying to pay for college is hard enough, but add diabetes and no insurance into the issue and they wonder why we aren't able to get the "higher" education. Especially right now when everyone is struggling and healthcare prices have gone up, jobs are scarce and even places like the free clinics are so overloaded they can't handle anymore. Usually it's not too much of a problem to fund tuition and other school related costs, it's the medical care.

Yep, a not-insignificant portion of my student loans (that I am still paying off) represent insulin and test strips! My college didn't offer a health plan with prescription drug coverage, and I obviously could not get insurance on the private market. I was fortunate to eventually land one of the few part-time jobs that offered insurance, but even that insurance did not offer decent Rx coverage.

And what you describe represents my point - for T1s diagnosed before the age of 18, this is a whole different ball game. I KNOW I would have done things differently had I not been so tied to the need for insurance and insulin. I have a hard time believing that this is the same issue T2s run into prior to the age of 22 when so many of these education and career choices are being made.

Crap acience again.

Just because you have a statistical set and see some similar data does not necessarily prove anything until clear detailed detective science and examination is done to see what
the links really are.

I wish idiots claiming to be scientists and not statistical hacks would no do these things. I agrre with others complaonts.

So, I wrote AHRQ and pointed out not just the limitations of the study, but also the fact that their blurb mushes all "diabetes" together, with implications that T1 can somehow be prevented. They emailed me back pretty quickly and have made significant revisions to the info on their site, both to clarify the limitations of the study and differentiate between T1 and T2.

Pretty cool....

http://www.ahrq.gov/research/nov12/1112RA5.htm

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